Periodontal condition and orofacial changes in patients with thalassemia major: a clinical and radiographic overview.

OBJECTIVE: To assess the prevalence of periodontal disease, orofacial changes and craniofacial abnormalities in patients with thalassemia major (TM). Dental management is discussed STUDY DESIGN: The sample consisted of 54 patients with TM, 31 males and 23 females aged 5.5 to 18.3 years, with the mean age (+/- SD) of 1.6 +/- 3.2 years. The sample was divided into two subgroups according to age. A similar number of unaffected control group matched by age and sex served as a control. Clinical and radiographic examinations were carried out to assess the prevalence of changes caused by this disorder. Student's t-test was used to compare the means between thalassemic group and the control group. The Chi-square test was employed to determine statistical differences in frequencies between the two groups. RESULTS: Poor oral hygiene and gingivitis were observed in 61.1% and 43.0% of the thalassemic patients, respectively. The overall mean plaque score was 1.66 +/- 0.51 and gingival score 1.43 +/- 0.59. In all tested periodontal parameters, a higher frequency and severity were noted in the thalassemic patients compared with controls. More than half of the patients exhibited frontal bossing, saddle nose and to less extent maxillary protrusion; giving in severe cases (16.7%) a "chipmunk" like appearance. Dental discoloration and pallor oral mucosa were noted in 44.4% and 38.9%, respectively. Dental/jaw pain was reported by 40.0% and headache by 29.6% of the patients. Increased overjet was evident in 25.9% of the patients. The majority of the patients had thickened frontal bone (66.7%), and thinned inferior border of the mandible (64.6%). Widened dipolic spaces and spiky roots and were observed in one-third of the patients. The ramus length and width in the patients were significantly smaller than in controls (P < 0.001). CONCLUSION: TM may particularly diagnose through orofacial abnormalities. Dentists required understanding the complications and management of the disease.

Coinheritance of two rare genodermatoses (Papillon-Lefèvre syndrome and oculocutaneous albinism type 1) in two families: a genetic study.

The co-occurrence of two rare recessive genetic conditions in apparently unrelated individuals or families is extremely rare. Two geographically distant and apparently unrelated families were identified in which individuals were simultaneously affected by two rare recessive mendelian syndromes, Papillon-Lefevre syndrome and type 1 oculocutaneous albinism. The families were tested for mutations in the causative genes, cathepsin C (CTSC) and tyrosinase (TYR), respectively, by direct sequencing. To assess the relationship of the two families, both families were tested for polymorphisms at eight microsatellite markers spanning both CTSC and TYR loci. Independent mutations (c.318-1G-->A and c.817G-->C/p.W272C) were identified in CTSC and TYR, respectively, that were shared by the affected individuals in both families. The two affected genes lie close together on chromosome bands 11q14.2-14.3, and studies with linked genetic markers suggested that the families shared a small chromosomal segment carrying both mutations that had been transmitted intact from a remote common ancestor. The co-occurrence of the two rare diseases in multiple families depends on their shared chromosomal location, but not on any shared pathogenic mechanism.

Oral health status of workers exposed to acid fumes in phosphate and battery industries in Jordan.

OBJECTIVES: To investigate the prevalence and nature of oral health problems among workers exposed to acid fumes in two industries in Jordan. SETTING: Jordan's Phosphate Mining Company and a main private battery factory. DESIGN: Comparison of general and oral health conditions between workers exposed to acid fumes and control group from the same workplace. SUBJECTS AND METHODS: The sample consisted of 68 subjects from the phosphate industry (37 acid workers and 31 controls) drawn as a sample of convenience and 39 subjects from a battery factory (24 acid workers and 15 controls). Structured questionnaires on medical and dental histories were completed by interview. Clinical examinations were carried out to assess dental erosion, oral hygiene, and gingival health using the appropriate indices. Data were statistically analysed using Wilcoxon rank-sum test to assess the significance of differences between results attained by acid workers and control groups for the investigated parameters. RESULTS: Differences in the erosion scores between acid workers in both industries and their controls were highly significant (P<0.05). In both industries, acid workers showed significantly higher oral hygiene scores, obtained by adding the debris and calculus scores, and gingival index scores than their controls (P<0.05). The single most common complaint was tooth hypersensitivity (80%) followed by dry mouth (77%) on average. CONCLUSION: Exposure to acid fumes in the work place was significantly associated with dental erosion and deteriorated oral health status. Such exposure was also detrimental to general health. Findings pointed to the need of establishing appropriate educational, preventive and treatment measures coupled with efficient surveillance and environmental monitoring for detection of acid fumes in the workplace atmosphere.

An unusual case of talon cusp on geminated tooth.

A rare case of talon cusp on geminated permanent central incisor is described. These developmental anomalies cause clinical problems including unsightly dental appearance, occlusal interference, displacement of the affected tooth, attrition, periodontopathy, irritation of the tongue, loss of space and malocclusion. Clinical and radiographic characteristics of these anomalies and modes of treatment are presented. Recognition of this condition and early diagnosis are important to avoid complications.

Caries risk in patients with thalassaemia major.

AIM: The aim of this study was to assess the prevalence and distribution of dental caries in subjects with thalassaemia major. DESIGN: Clinical examination for dental caries, diagnosed according to the WHO criteria. PARTICIPANTS: A total of 54 thalassaemic patients, 23 aged 6-9 (14 males and 9 females) and 31 aged 12-18 (17 males and 14 females) were examined. OUTCOME MEASURES: dmft, DMFT and plaque scores. RESULTS: The mean dmft was 6.92 for 6-7 year olds and 4.72 for 8-9 year olds. The DMFT values were 6.57 and 5.95 for ages 12-14 and 15-18, respectively. There was no statistically significant difference in caries prevalence (dmft/DMFT) between gender or between primary and permanent teeth. Only 17.4 per cent of the children aged 6-9 and 21.4 per cent of 12-18 years olds were caries free. The prevalence of dental caries in the thalassaemia patients was considerably higher (22.7 per cent) than that reported in a normal Jordanian sample (DMFT 6.26 vs 4.84). Very few fillings (1.4 per cent of the examined teeth) were observed, indicating a negligible rate of conservative treatment. More than half (61.1 per cent) of the patients had poor oral hygiene (plaque score > or = 2.0). CONCLUSIONS: The need for effective preventive measures, education and dental treatment need to be stressed for this caries risk group.

Fluoride release from glass ionomer restorative materials and the effects of surface coating.

OBJECTIVES: This in vitro study on fluoride (F) release from conventional and metal-reinforced glass ionomer investigated the following: (1) the release of F in deionized water compared to artificial saliva, (2) the effect of various surface coatings on F release, (3) the uptake of released F by hydroxyapatite, (4) the expression of the release data in a mathematical model, (5) F content in the powders and set materials, and (6) surface morphology of varnished and resin-coated specimens. METHODS: Glass ionomer Ketac-Fil (KF), Fuji II (FJ), and Ketac-Silver (KS) were mixed according to the manufacturers' instructions, and prepared into specimens of 137.8 mm2 surface area. All three specimens were suspended in 50 ml of deionized water, artificial saliva, or aqueous solution of hydroxyapatite and submitted to constant agitation at 37 degrees C. In a separate experiment, the specimens were coated with varnish or light-cured bonding resin and tested for F release in solutions similar to those for uncoated specimens. The release of F occurred for 28 days. The concentration of F was measured with F-ion-specific electrode. RESULTS: All tested products showed a strong initial rate of F release which decreased with time until it reached a relatively steady rate after two weeks. The F released from KF and FJ was comparable in both pattern and magnitude. They released approximately four times more F than KS. In all cases, the release of F in artificial saliva was significantly (p < 0.001) less than in deionized water. Surface coating the specimens significantly reduced the F release ( p < 0.05 top < 0.001, depending on the product and type of coating). The inhibitory effect of coating markedly decreased with time. Resin coating reduced F release more than varnish in KF and KS, but not for FJ. Essentially, all F released in aqueous solution was taken up by the hydroxyapatite, with FJ ranking the highest in increasing hydroxyapatite F concentration. Over the 28 days, the quantities of F released from FJ, KF, and KS were, respectively, 3.8, 2.3, and 1.0% of the total F content in the specimens. The F concentration in the set KS was 53.9 and 72.5% of that found in KF and FJ, respectively. The release data as a function of time were best described by the power curve. Micromorphological examinations revealed remnants of surface coatings on specimens after 14 days storage in artificial saliva. CONCLUSIONS: Glass ionomer cements released significantly less F in artificial saliva than in deionized water. Surface coating the specimens substantially reduced F release. These clinically relevant factors were not considered by many in vitro release studies which overestimate the F availability from glass ionomers. A recall appointment 24 h after the placement of glass ionomer restoration should be given for surface finishing.

Fluoride content in khat (Catha edulis) chewing leaves.

Khat (qat) leaves are chewed for their psychostimulative effects; there is an unconfirmed suggestion that they contain a high concentration of fluoride (F). Khat samples from Yemen were suspended in deionized water, spun, and the supernatants exposed to a chelator that decomplexes F, which was assayed with an F(-)-electrode coupled to an ion analyser. F released into whole saliva after chewing khat for 15 min and from khat suspended in stimulated whole saliva for 1.5 h in vitro was measured also. Total F in dried khat leaves and their ash was assayed by the acid-hexamethyldisiloxane microdiffusion method. All methods demonstrated negligible amounts of F in or from khat leaves (<0.02 microg F/ml leached into water or saliva; 0.06 microg F/ml in saliva after chewing; 0.93 microg total F/g in dried leaf, 2.07 microg total F/g in ash).

Etiology and diagnosis of tooth wear: a literature review and presentation of selected cases.

PURPOSE: This article presents an overview of etiologies associated with tooth wear. MATERIALS AND METHODS: Specific types of wear based on clinical findings and patient history are described. RESULTS: The occurrence and pattern of tooth wear are related to cultural, dietary, occupational, and geographic factors. Examples of tooth wear related to these factors with regional specificity are presented. CONCLUSION: The dental practitioner should recognize the characteristic signs of tooth wear, as they may be the first to discuss the problem with the patient. Management should be based on accurate diagnosis.

Clinical problems associated with unusual cases of talon cusp.

CASE REPORT: Talon cusp is an uncommon dental anomaly manifested as an accessory cusp-like structure on the crown of anterior teeth. This report describes two unusual cases of talon cusp. Case 1 showed bilateral anomalous cusps on the palatal aspects of maxillary supernumerary teeth, causing premature contact and tooth impaction. In case 2, a double-fused talon cusp was projected from the palatal surface of a large geminated central incisor. A talon cusp is not an innocuous defect, as it may provide a substantial diagnostic, treatment planning and procedural challenge. Early diagnosis and management are important to avoid complications.

Radiographic evaluation of mandibular third molar eruption space.

OBJECTIVE: The purpose of this study was to investigate variables in third molar and arch dimensions among subjects with impacted and erupted mandibular third molars. STUDY DESIGN: Standardized panoramic radiographs were taken for 134 subjects (60 males and 74 females with 213 third molars) with an average age of 19.8 years. For the impacted group, only those who had mesioangular inclination of the third molars were recorded. The radiographic features studied were angulation of tooth, level of eruption, development of root, mesiodistal crown width, retromolar space, and gonial angle. RESULTS: Third molar angulation in the impacted group (69 subjects with 101 third molars) averaged 16.28 degrees (SD +/- 11.88 degrees), with no significant gender differences. The retromolar space was significantly smaller in the impacted group than in the erupted group (P < .001). This space was also the only significant variable (P < .05) associated with lateral asymmetry in the eruption/impaction status of third molars. In the impacted group, 83% of subjects had third molar space/crown width ratios less than 1, whereas in the erupted group 69% had ratios of at least 1. The average space/crown width ratios in the impacted and erupted groups were 0.78 and 1.06, respectively (P < .001). The impacted and erupted groups did not differ significantly with respect to mesiodistal crown width and gonial angle. Approximately 76% of impacted third molars had complete root formation, 20% had two thirds root formation, and only 4% displayed one third root formation. Of the impacted third molars, 66% were partially erupted and the rest were unerupted. There was a strong positive relationship between frequency of third molar impaction and degree of angulation (P < .001), but the former was inversely associated with retromolar space (P < .001). CONCLUSIONS: The most significant variable associated with third molar impaction is inadequate space. The vast majority of impacted third molars had space/crown width ratios of less than 1.

Dental discoloration: an overview.

UNLABELLED: Often the first evidence of variation from normal in human dentition is an observable difference in the color of the teeth. During the past decade, the demand for conservative esthetic dentistry has grown dramatically. Tooth discoloration is a frequent dental finding, associated with clinical and esthetic problems. It differs in etiology, appearance, composition, location, severity, and firmness in adherence to the tooth surface. Basically, there are two types of tooth discolorations: those caused by extrinsic factors and those caused by intrinsic congenital or systemic influence. The intensity of stains may be worsened if there are enamel defects. Tooth discoloration presents two major challenges to the dental team. The first challenge is to ascertain the cause of the stain; the second is its management. CLINICAL SIGNIFICANCE: This article reviews the etiology and clinical presentation of dental stains and outlines treatment options.

Oral manifestations of Ellis-van Creveld syndrome: report of two siblings with unusual dental anomalies.

Ellis-van Creveld syndrome (EvC), also called chondroectodermal dysplasia, is a rare occurrence inherited as an autosomal recessive disease. Despite the fact that oral manifestations play an important role in the diagnosis criteria for EvC, few detailed reports have been published in the dental literature. This articles presents two siblings with EvC, a boy aged 9 years and a girl aged 7 1/2 years, a product of unaffected first cousin parents. The patients manifests: chondrodysplasia of tubular bones resulting in disproportionate dwarfism, polydactyly and syndactyly of hands and feet, severe dystrophic nails, multiple broad labial frenula with abnormal attachments, congenital missing incisors, anomalous teeth, bilateral partial clefts of the alveolar bone, and malocclusion. Other features noted in either cases are: congenital heart defect, median notch of the upper lip, shovel-shaped incisors and taurodontism. Of the unusual dental findings observed in our patients are talon cusp, reduced crown size, supernumerary tooth, and early eruption of teeth. Because half of the cases with EvC have cardiac malformation, dental treatment must be performed under prophylactic antibiotic coverage. Dentists play an important role in early diagnosis and control of dental problem of this condition.

Oligodontia of the permanent dentition in two sisters with polycystic ovarian syndrome: case reports.

Oligodontia or severe hypodontia is a rare developmental dental anomaly commonly associated with syndromes and systemic abnormalities. This report presents two sister, aged 18 and 21, who collectively had 56 congenitally missing permanent teeth. Both patients exhibited pubertal hirsutism, menstrual disturbances, and enlarged ovaries with multicystic lesions defined ultrasonically. These features are consistent with the diagnosis of polycystic ovarian syndrome, a disease not previously linked to hypodontia. A genetic component of this condition is proposed. The significance of this entity is discussed and the importance of early diagnosis and treatment regimens are emphasized.

Meswak: the natural toothbrush.

The use of a wood stick (meswak or chewing stick) for brushing the teeth continues to be an important tool for oral hygiene care in many Afro-Asian communities. It is inexpensive, customary and used for religious reasons as well. Despite the wide use of meswak, information on its chemical and pharmaceutical contents are scant, particularly in regard to an anticaries effect. In the present study, sticks from Salvadora persica, the most common source for meswak, were analyzed for their soluble and total content of fluoride, calcium, phosphorus and silica. Results showed that the fluoride released from meswak soaked in water was negligible (< 0.07 microgram/ml). Approximately 39% of the total fluoride in the sticks was in a form that could be leached out. The leached calcium and phosphorus averaged 582 micrograms/ml and 34 g/ml, respectively, representing 19.6% and 26.4% of their total content in the sticks. There was a substantial amount of silica in the ashes of meswak. It appears that meswak is probably not particularly active against caries through its fluoride content, but it does act as a brush for removing dental plaque and polishing the teeth.

Positional changes and eruption of impacted mandibular third molars in young adults. A radiographic 4-year follow-up study.

OBJECTIVE: To measure changes in angular position and eruption status of mesially impacted mandibular third molars (M3) during 4-year follow-up period. STUDY DESIGN: Standardized panoramic radiographs were taken at the start of the study (the average age of the subjects was 19.7 years) and 4 years later. Angulation and degree of impaction of M3 were determined by their sagittal relationships to the adjacent second molars. The impacted M3 were either partially erupted or unerupted. RESULTS: Initial examination showed that among a total of 59 mesioangular M3, 49 (83%) had inclination between 5 and 30 degrees. The proportion of M3 that became upright (zero tilt) was 76% (13/17) with initial angulations of 5 to 10 degrees, 61% (11/18) with initial angulations of 15 to 20 degrees, and 14% (2/14) with initial angulations of 25 to 30 degrees. None of the M3 originally presented at 35 degrees or more became upright, but an average decrease of 12 degrees in angulation was registered. In total, 26 M3 of 59 (44%) became upright during the follow-up period. Initial examination of levels of eruption showed that among 59 M3, 13 (22%) were partially erupted and the rest were unerupted. Of the 46 M3 initially unerupted, 17 (37%) became fully erupted and 7(15%) erupted partially during the 4-year follow-up. Of the total sample, 25 (42%) had erupted to full occlusion during the observation period. CONCLUSION: A significant proportion of mesially impacted mandibular M3 had changed their angulation and became fully erupted by the time the individual reached 24 years of age. Positional changes and eruption of impacted M3 are unpredictable phenomena.

Bilateral talon cusps on primary central incisors: a case report.

Talon cusp is an uncommon anomaly in the primary dentition. The present report describes a case of bilateral talon cusps on the maxillary primary central incisors of a 17-month-old Jordanian-Arab boy, bringing to seven the total cases reported in the literature. Both central incisors exhibited a sharp prominent accessory cusp on the palatal surface which extended from the cemento-enamel to the incisal edge. The cusp on the right incisor was attached to tooth surface, forming a T-shape crown outline. whereas the cusp on the left incisor projected away from the rest of the crown. The anomalous cusps were a source of tongue irritation and occlusal interference.